Why Your RA Went Into Remission, but Relapsed

Most RA patients can achieve remission, but it doesn’t always last. Here’s a look at why -- and what you can do to keep symptoms at bay.

RA Insider, Newsletter of Arthritis Foundation—January 1, 2014

Stopping Medication Can Trigger Relapse

One reason that some patients with RA have a remission relapse is simple: They stop taking their medications. However, that’s not necessarily because the patient has become forgetful or has purposely skipped a dose. When an RA patient achieves remission, some doctors will taper treatment, either by decreasing the dose of medication or increasing the time between treatments (such as giving a biologic drug every other week instead of weekly). In other cases, a doctor might decide a patient can attempt to go without any medication at all. The purpose of reducing or eliminating a patient’s medication is to minimize the risk of side effects that accompany today’s powerful new medications.

However, these strategies aren’t right for all patients, and someone who had been in remission can have their symptoms return, explains rheumatologist Theodore Fields, MD, clinical director of the Early Arthritis Initiative in the Inflammatory Arthritis Center at New York City’s Hospital for Special Surgery. “I have some patients who have been off medication for a couple of years and stayed in remission,” says Dr. Fields. But that’s true for only a small number of patients, he’s quick to add. Researchers have attempted to determine more precisely what number of RA patients in remission remain symptom-free after discontinuing biologic therapy, but the handful of studies examining this question have failed to produce a clear answer, according to a 2013 scientific review in Clinical Therapeutics.

See Your Doctor if You Relapse

If you are in remission and joint pain and stiffness start to flare, tell your doctor soon. “Flares are important,” says Dr. Fields. “They may be telling you that a drug that was initially working is losing its effectiveness.” Seeing your doctor promptly allows him or her to adjust your treatment plan, which can prevent serious damage to your joints and help you feel better.